Heartburn and reflux disease treatment apparatus

ABSTRACT

A heartburn and reflux disease treatment apparatus comprises an electric stimulation device ( 56 ) adapted to engage the cardia sphincter ( 58 ) of a patient, who suffers from heartburn and reflux disease, and electrically stimulate the cardia sphincter to increase the sphincter tonus, so that the cardia completely closes. A control device ( 62 ) is provided for controlling a source of energy ( 64 ), which may or may not be implanted, to release electric energy for use in connection with the power of the stimulation device.

The present invention relates to a heartburn and reflux diseasetreatment apparatus

Heartburn and reflux disease is a widespread medical problem. This isoften due to hiatal hernia, i.e. a portion of the stomach immediatelybelow the gastric fundus slides upwardly through the esophageal hiatus.In consequence, stomach acids and foods are regurgitated into theesophagus.

In the late 1970s a prior art restriction device called Angelchik,according to U.S. Pat. No. 3,875,928, was used to operatively treatheartburn and reflux disease. However, the Angelchik restriction devicehad a major disadvantage in that it was not possible to adjust the sizeof the restriction opening after the operation. A further disadvantagewas that the restriction device did not satisfactorily protect theesophagus and the surrounding area against injuries due to poor shape ofthe restriction device. Therefore, operations using the Angelchikstimulation device are no longer practised.

An operation technique, semi-fundoduplicatio, is currently in use fortreating heartburn and reflux disease. A most common operation is Nissensemi-fundoduplicatio, in which one takes the fundus of the stomach andmakes a three-quarter of a turn around the esophagus and suture betweenthe stomach and esophagus. Although this operation works fairly well ithas three main disadvantages. Firstly, most patients' treated inaccordance to “ad modum Nissen” lose their ability to belch. Secondly,many of these patients's get dysphagia, i.e. difficulties to swallowafter the operation. Thirdly, it is not possible to adjust the foodpassageway in the esophagus or stomach in any way after the operation.Characteristic for these patients's is the variation of their problemsover the day. For example, many patients have difficulties during thenight when they lie down because of stomach acid leaking up into theesophagus.

It is an object of the present invention to provide a new convenientheartburn and reflux disease treatment apparatus, the performance ofwhich may be affected by the patient at any time after operation, inparticular when various needs arise over the day, so that the patientalways is satisfied.

This object is achieved by a heartburn and reflux disease treatmentapparatus, which is characterised by an implantable electric stimulationdevice adapted to engage with the cardia sphincter of a patient, whosuffers from heartburn and reflux disease, and electrically stimulatethe cardia sphincter to increase the sphincter tonus, so that the cardiacompletely closes. (The term “patient” includes an animal or a humanbeing.

The apparatus preferably comprises a source of energy and a controldevice controllable from outside the patient's body for controlling thesource of energy to release energy for use in connection with the powerof the stimulation device, when the stimulation device is implanted. Asa result, the apparatus of the invention provides a simple and effectivecontrol of the energy supplied to implanted components of the apparatuswhich ensures an extended and reliable functionality of the apparatus,possibly for the rest of the patient's life and at least many years.

An important problem is that the voltage intensity strong enough toprovide the desired stimulation of the cardia sphincter might fade overtime, due to increasing electric resistance caused by the formation offibrosis where the conductors engage the cardia sphincter. This problemis solved by a main embodiment of the present invention, in which theelectric source of energy provides a current through the electricconductors. More particularly, the control device is adapted to controlthe electric source of energy to release electric energy such that theintensity of the current through the electric conductors amounts to apredetermined value. As a result, decreasing current intensity caused bythe formation of fibrosis where the conductors engage the cardiasphincter can be compensated for. Thus, if the current through theconductors decreases the control device automatically controls theelectric source of energy to release more electric energy to restore thedesired current intensity.

Advantageously, the control device is adapted to control the electricsource of energy to release energy in the form of an alternatingcurrent. The inventor has found that unlike an alternating current adirect current could cause electrolysis in the cardia sphincter. Suchelectrolysis could injure the cardia sphincter.

The control device may also control the stimulation device.

In accordance with a preferred embodiment of the invention, the sourceof energy comprises an electric source of energy and the control deviceis adapted to supply the stimulation device with electric energy fromthe electric source of energy. In the preferred embodiment, the controldevice is adapted to control the stimulation device to vary theintensity of the electric stimulation of the cardia sphincter over time.Preferably, the control device is controllable from outside thepatient's body to control the stimulation device to change the intensityof the electric stimulation of the cardia sphincter so that the cardiasphincter tonus is changed.

All of the above embodiments may be combined with at least oneimplantable sensor for sensing at least one physical parameter of thepatient, wherein the control device may control the stimulation devicein response to signals from the sensor. In particular, the sensor maysense as the physical parameter the contraction wave in the esophaguscaused by the patient swallowing food. In this case the electricstimulation device is adapted to cease the stimulation of the cardiasphincter in response to the sensor sensing the contraction wave in thepatient's esophagus.

As an alternative, the sensor may comprise a pressure sensor fordirectly or indirectly sensing the pressure in the esophagus. Theexpression “indirectly sensing the pressure in the esophagus” should beunderstood to encompass the cases where the sensor senses the pressureagainst the stimulation device or human tissue of the patient.

The control device may comprise an internal control unit, preferablyincluding a microprocessor, to be implanted in the patient forcontrolling the stimulation device. The internal control unit maysuitably directly control the stimulation device in response to signalsfrom the sensor. In response to signals from the sensor, for examplepressure, the patient's position, the contraction wave in the patient'sesophagus or any other important physical parameter, the internalcontrol unit may send information thereon to outside the patient's body.The control unit may also automatically control the stimulation devicein response to signals from the sensor. For example, the control unitmay control the stimulation device to efficiently stimulate the cardiasphinter, such that the cardia for certain is completely closed inresponse to the sensor sensing that the patient is lying.

The control device may also, or alternatively, comprise an externalcontrol unit outside the patient's body, wherein the internal controlunit is programmable by the external control unit, for example forcontrolling the stimulation device over time. Alternatively, theinternal control unit may control the stimulation device over time inaccordance with an activity schedule program, which may be adapted tothe patient's needs.

The external control unit may also, suitably directly, control thestimulation device in response to signals from the sensor. The externalcontrol unit may store information on the physical parameter sensed bythe sensor and may be manually operated to control the stimulationdevice based on the stored information. In addition, there may be atleast one implantable sender for sending information on the physicalparameter sensed by the sensor.

A great advantage is that the patient is enabled to keep the cardiacompletely closed by means of the stimulation device by using thecontrol device whenever he likes during the day. This advantage shouldnot be underestimated, because in case the patient would need to vomitit would be very difficult for him to do so if he were unable toimmediately stop the electric stimulation of the cardia.

Conveniently, the external control unit may load the internal controlunit with data in accordance with a loading mode only authorised for adoctor. For specialised controls of the stimulation device, such aselectric power, electric pulse frequency etc, the external control unitmay control the internal control unit in accordance with a doctor modeonly authorised for the doctor. For simple controls of the stimulationdevice, such as on and off, the external control unit may control theinternal control unit in accordance with a patient mode permitted forthe patient. Thus, by using the external control unit in accordance withdifferent modes it is possible to have certain functions of thestimulation device controlled by the patient and other more advancedfunctions controlled by the doctor, which enables a flexiblepost-operation treatment of the patient.

The control device may be adapted to control the source of energy torelease energy, for instance to intermittently release energy in theform of a train of energy pulses, for direct use in connection with thepower of the stimulation device. In accordance with a suitableembodiment the control device controls the source of energy to releaseelectric energy, and the apparatus further comprises an implantablecapacitor for producing the train of energy pulses from the releasedenergy. In this case the term “direct” is used to mean, on one hand,that the released energy is used while it is being released by thecontrol device, on the other hand, that the released energy may besomewhat delayed, in the order of seconds, by for instance an energystabiliser before being used in connection with the power of thestimulation device.

In accordance with an embodiment of the invention, the apparatuscomprises implantable electrical components including at least one, oronly one single voltage level guard and a capacitor or accumulator,wherein the charge and discharge of the capacitor or accumulator iscontrolled by use of the voltage level guard.

In accordance with a first main aspect of the invention, the source ofenergy is external to the patient's body and the control device controlsthe source of energy to release wireless energy. An energy storagedevice, preferably an electric accumulator, may be implanted in thepatient for storing the wireless energy released from the externalsource of energy. The electric accumulator may comprise at least onecapacitor or at least one rechargeable battery, or a combination of atleast one capacitor and at least one rechargeable battery.Alternatively, a battery may be implanted in the patient for supplyingelectric energy to implanted electric energy consuming components of theapparatus, in addition to the supply of wireless energy. Where thecontrol device comprises an implantable control unit the electroniccircuit thereof and the stimulation device may be directly powered withtransformed wireless energy, or energy from either the implanted energystorage device or battery.

In accordance with a second main aspect of the invention, the wirelessenergy is directly used for the power of the stimulation device, i.e.the stimulation device is powered as the wireless energy is releasedfrom the external source of energy by the control device. In this casethe term “directly” is used to mean, on one hand, that the stimulationdevice is promptly powered by using the released energy whiteout firststoring the latter, on the other hand, that the released energy may besomewhat delayed, in the order of seconds, by for instance an energystabiliser before being used for the power of the stimulation device. Asa result, a very simple control of the stimulation device is achievedand there are only a few implanted components of the apparatus. Forexample, there is no implanted source of energy, such as a battery, norany implanted complicated signal control system. This gives theadvantage that the apparatus will be extremely reliable.

In accordance with a third main aspect of the invention, the source ofenergy comprises an implantable internal source of energy. Thus, whenthe internal source of energy is implanted in a patient the controldevice controls it from outside the patient's body to release energy.This solution is advantageous for sophisticated embodiments of theapparatus that have a relatively high consumption of energy that cannotbe satisfied by direct supply of wireless energy.

The internal source of energy preferably comprises an electric source ofenergy, such as an accumulator or a battery.

In accordance with a fourth main aspect of the invention, the apparatuscomprises a switch implanted in the patient for directly or indirectlyswitching the power of the stimulation device and an internal electricsource of energy, such as a battery, implanted in the patient forsupplying electric energy for the power of the stimulation device,wherein the switch directly or indirectly affects the supply of electricenergy from the internal electric source of energy. This solution isadvantageous for embodiments of the apparatus that have a relativelyhigh consumption of energy that cannot be met by direct supply ofwireless energy.

In a first particular embodiment in accordance with the fourth mainaspect of the invention, the switch switches between an off mode, inwhich the internal electric source of energy is not in use, and an onmode, in which the internal electric source of energy supplies electricenergy for the power of the stimulation device. In this case, the switchis conveniently operated by the wireless energy released from theexternal source of energy to switch between the on and off modes. Thecontrol device, preferably comprising a wireless remote control, maycontrol the external source of energy to release the wireless energy.The advantage of this embodiment is that the lifetime of the implantedelectric source of energy, such as a battery, can be significantlyprolonged, since the implanted source of energy does not supply energywhen the switch is in its off mode.

In a second particular embodiment in accordance with the fourth mainaspect of the invention, the control device comprises a wireless remotecontrol for controlling the internal electric source of energy. In thiscase, the switch is operable by the wireless energy from the externalsource of energy to switch between an off mode, in which the internalelectric source of energy and remote control are not in use, and astandby mode, in which the remote control is permitted to control theinternal electric source of energy to supply electric energy for thepower of the stimulation device.

In a third particular embodiment in accordance with the fourth mainaspect of the invention, the apparatus further comprises an energytransforming device to be implanted in the patient for transforming thewireless energy into storable energy, and an implantable energy storagedevice for storing the storable energy, wherein the switch is operableby energy from the implanted energy storage device to switch between anoff mode, in which the internal electric source of energy is not in use,and an on mode, in which the internal electric source of energy supplieselectric energy for the power of the stimulation device. In this case,the control device suitably comprises a wireless remote control forcontrolling the energy storage device to operate the switch.

An external data communicator may be provided outside the patient's bodyand an internal data communicator to be implanted in the patient may beprovided for communicating with the external data communicator. Theinternal data communicator may feed data related to the patient, orrelated to the stimulation device, back to the external datacommunicator. Alternatively or in combination, the external datacommunicator may feed data to the internal data communicator. Theinternal data communicator may suitably feed data related to at leastone physical signal of the patient.

Suitably, an implantable stabiliser, such as a capacitor, a rechargeableaccumulator or the like, may be provided for stabilising the electricenergy released by the control device. In addition, the control devicemay control the source of energy to release energy for a determined timeperiod or in a determined number of energy pulses.

All of the above embodiments are preferably remote controlled. Thus, thecontrol device advantageously comprises a wireless remote controltransmitting at least one wireless control signal for controlling thestimulation device. With such a remote control it will be possible toadapt the function of the apparatus to the patient's need in a dailybasis, which is beneficial with respect to the treatment of the patient.

The wireless remote control may be capable of obtaining information onthe condition of the stimulation device and of controlling thestimulation device in response to the information. Also, The remotecontrol may be capable of sending information related to the stimulationdevice from inside the patient's body to the outside thereof.

In a particular embodiment of the invention, the wireless remote controlcomprises at least one external signal transmitter or transceiver and atleast one internal signal receiver or transceiver implantable in thepatient. In another particular embodiment of the invention, the wirelessremote control comprises at least one external signal receiver ortransceiver and at least one internal signal transmitter or transceiverimplantable in the patient.

The remote control may transmit a carrier signal for carrying thecontrol signal, wherein the carrier signal is frequency, amplitude orfrequency and amplitude modulated and is digital, analogue or digitaland analogue. Also the control signal used with the carrier signal maybe frequency, amplitude or frequency and amplitude modulated.

The control signal may comprise a wave signal, for example, a sound wavesignal, such as an ultrasound wave signal, an electromagnetic wavesignal, such as an infrared light signal, a visible light signal, anultra violet light signal, a laser signal, a micro wave signal, a radiowave signal, an x-ray radiation signal, or a gamma radiation signal.Where applicable, two or more of the above signals may be combined.

The control signal may be digital or analogue, and may comprise anelectric or magnetic field. Suitably, the wireless remote control maytransmit an electromagnetic carrier wave signal for carrying the digitalor analogue control signal. For example, use of an analogue carrier wavesignal carrying a digital control signal would give safe communication.The control signal may be transmitted in pulses by the wireless remotecontrol.

The control device may be activated in a manual or non-manual manner tocontrol the source of energy to release energy.

In the above-presented embodiments of the invention the released energymay comprise electric energy and an implantable capacitor having acapacity less than 0,1 μF may be provided for producing theabove-mentioned train of energy pulses.

Generally, the wireless energy comprises a signal.

The apparatus may further comprise an implantable energy transformingdevice for transforming wireless energy, for example in the form ofsound waves, directly or indirectly into electric energy, for the powerof the stimulation device. More specifically, the energy transformingdevice may comprise a capacitor adapted to produce electric pulses fromthe transformed electric energy.

Generally, the stimulation device advantageously is embedded in a softor gel-like material, such as a silicone material having hardness lessthan 20 Shore.

The stimulation device may comprise a band for application around thecardia, wherein the band has electric conductors for contacting thecardia sphincter. The electric conductors may comprise hooks to securethe conductors on the cardia.

All the above described various components may be combined in thedifferent embodiments where applicable. Also the various functionsdescribed in connection with the above embodiments of the invention maybe used in different applications, where applicable.

All the various ways of transferring energy and controlling the energypresented in the present specification may be practised by using all ofthe various components and solutions described.

The present invention also provides methods for treating heartburn andreflux disease.

Accordingly, in accordance with a first alternative method, there isprovided a method of treating heartburn and reflux disease, comprisingthe steps of implanting an electric stimulation device in a patient, sothat the stimulation device engages the cardia, providing an electricsource of energy, and controlling the electric source of energy to powerthe stimulation device to electrically stimulate the cardia sphincter toincrease the sphincter tonus, so that the cardia completely closes.

The first alternative method may also be performed laparascopically.Thus, there may be provided a laparascopic method of treating heartburnand reflux disease, comprising the steps of laparasopically implantingan electric stimulation device in a patient, so that the stimulationdevice engages the cardia, providing an electric source of energy, andcontrolling the electric source of energy to power the stimulationdevice to electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes.

In accordance with a second alternative method, there is provided amethod of treating a patient having heartburn and reflux disease,comprising: (a) Surgically implanting in the patient an electricstimulation device engaging the cardia. (b) Providing a source of energyexternal to the patient's body. (c) Controlling the external source ofenergy from outside the patient's body to release wireless energy. And(d) using the released wireless energy in connection with the poweringof the stimulation device.

The second alternative method may further comprise implanting an energytransforming device, controlling the external source of energy torelease wireless energy, and transforming the wireless energy by theenergy transforming device into energy different from the wirelessenergy for use in connection with the power of the stimulation device.This method may further comprise implanting a stabiliser in the patientfor stabilising the energy transformed by the energy-transformingdevice.

The invention is described in more detail in the following withreference to the accompanying drawings, in which

FIG. 1 is a schematic block diagram illustrating an embodiment of theheartburn and reflux disease apparatus of the invention, in whichwireless energy is released from an external source of energy for use inthe power of a stimulation device;

FIG. 2 is a schematic block diagram illustrating another embodiment ofthe invention, in which wireless energy is released from an internalsource of energy;

FIGS. 3 to 6 are schematic block diagrams illustrating four embodiments,respectively, of the invention, in which a switch is implanted in thepatient for directly or indirectly switching the power of thestimulation device;

FIG. 7 is a schematic block diagram illustrating conceivablecombinations of implantable components for achieving variouscommunication options;

FIG. 8 illustrates the apparatus in accordance with the inventionimplanted in a patient; and

FIG. 9 is a block diagram illustrating remote control components of anembodiment of the invention.

Referring to the drawing figures, like reference numerals designateidentical or corresponding elements throughout the several figures.

FIG. 1 schematically shows an embodiment of the heartburn and refluxdisease apparatus of the invention having some parts implanted in apatient and other parts located outside the patient's body. Thus, inFIG. 1 all parts placed to the right of the patient's skin 2 areimplanted and all parts placed to the left of the skin 2 are locatedoutside the patient's body. The apparatus of FIG. 1 comprises animplanted electric stimulation device 4, which engages the patient'scardia sphincter to provide electric connection thereto. An implantedcontrol unit 6 controls the stimulation device 4 via a control line 8.An external control unit 10 includes an external source of energy and awireless remote control transmitting a control signal generated by theexternal source of energy. The control signal is received by a signalreceiver incorporated in the implanted control unit 6, whereby thecontrol unit 6 controls the implanted stimulation device 4 in responseto the control signal. The implanted control unit 6 also uses electricenergy drawn from the control signal for powering the stimulation device4 via a power supply line 12.

FIG. 2 shows an embodiment of the invention identical to that of FIG. 1,except that an implanted internal electric source of energy in the formof a battery 42 is substituted for the external source of energy. Thus,an external control unit 40 without any source of energy is used in thisembodiment. In response to a control signal from the external controlunit 40 the implanted control unit 6 powers the stimulation device 4with energy from the battery 42.

FIG. 3 shows an embodiment of the invention comprising the stimulationdevice 4, the external control unit 10, and an implanted source ofenergy 236 and an implanted switch 238. The switch 238 is operated bywireless energy released from the external source of energy of theexternal control unit 6 to switch between an off mode, in which theimplanted source of energy 236 is not in use, and an on mode, in whichthe implanted source of energy 236 supplies energy for the power of thestimulation device 4.

FIG. 4 shows an embodiment of the invention identical to that of FIG. 3,except that also the control unit 6 is implanted, in order to receive acontrol signal from the wireless remote control of the external controlunit 10. The switch 238 is operated by the wireless energy from theexternal source of energy 10 to switch between an off mode, in which theimplanted source of energy 236 and the wireless remote control of theexternal control unit 10 are not in use, i.e. the control unit 6 is notcapable of receiving the control signal, and a standby mode, in whichthe wireless remote control is permitted to control the internal sourceof energy 236, via the implanted control unit 6, to supply energy forthe power of the stimulation device 4.

FIG. 5 shows an embodiment of the invention identical to that of FIG. 4,except that an energy transforming device for transforming the wirelessenergy into storable energy is incorporated in the implanted controlunit 6 and that the implanted source of energy 236 is of a type that iscapable of storing the storable energy. In this case, in response to acontrol signal from the external control unit 10, the implanted controlunit 6 controls the switch 238 to switch from an off mode, in which theimplanted source of energy 236 is not in use, to an on mode, in whichthe source of energy 36 supplies energy for the power of the stimulationdevice 4.

FIG. 6 shows an embodiment of the invention identical to that of FIG. 5,except that an energy storage device 240 also is implanted in thepatient for storing the storable energy transformed from the wirelessenergy by the transforming device of the control unit 6. In this case,the implanted control unit 6 controls the energy storage device 240 tooperate the switch 238 to switch between an off mode, in which theimplanted source of energy 236 is not in use, and an on mode, in whichthe implanted source of energy 236 supplies energy for the power of thestimulation device 4.

FIG. 7 schematically shows conceivable combinations of implantedcomponents of the apparatus for achieving various communicationpossibilities. Basically, there are the implanted stimulation device 4,the implanted control unit 6 and the external control unit 10 includingthe external source of energy and the wireless remote control. Asalready described above the remote control transmits a control signalgenerated by the external source of energy, and the control signal isreceived by a signal receiver incorporated in the implanted control unit6, whereby the control unit 6 controls the implanted stimulation device4 in response to the control signal.

A sensor 54 may be implanted in the patient for sensing a physicalparameter of the patient, such as the pressure in the esophagus. Thecontrol unit 6, or alternatively the external control unit 10, maycontrol the stimulation device 4 in response to signals from the sensor54. A transceiver may be combined with the sensor 54 for sendinginformation on the sensed physical parameter to the external controlunit 10. The wireless remote control of the external control unit 10 maycomprise a signal transmitter or transceiver and the implanted controlunit 6 may comprise a signal receiver or transceiver. Alternatively, thewireless remote control of the external control unit 10 may comprise asignal receiver or transceiver and the implanted control unit 6 maycomprise a signal transmitter or transceiver. The above transceivers,transmitters and receivers may be used for sending information or datarelated to the stimulation device from inside the patient's body to theoutside thereof. For example, the battery 32 may be equipped with atransceiver for sending information on the charge condition of thebattery.

Those skilled in the art will realise that the above various embodimentsaccording to FIGS. 1-6 could be combined in many different ways.

FIG. 8 illustrates how any of the above-described embodiments of theheartburn and reflux disease treatment apparatus of the invention may beimplanted in a patient. Thus, an assembly of the apparatus implanted inthe patient comprises a stimulation device in the form of a band 56,which is wrapped around the cardia 58. The band 58 is provided withconductors that electrically contact the cardia sphincter and anoperation device 60 for operating the stimulation device 56. Animplanted control unit 60 is provided for controlling the supply ofelectricity to the band 56. There is an implanted energy transformingdevice 62 for transforming wireless energy into electric energy. Thetransforming device 62 also includes a signal receiver. An externalcontrol unit 64 includes a signal transmitter for transmitting a controlsignal to the signal receiver of the implanted transforming device 62.The transforming device 62 is capable of transforming signal energy fromthe control signal into electric energy for powering the stimulationdevice 60 and for energising other energy consuming implanted componentsof the apparatus.

FIG. 9 shows the basic parts of a wireless remote control Of theapparatus of the invention including an implanted electric stimulationdevice 4. In this case, the remote control is based on the transmissionof electromagnetic wave signals, often of high frequencies in the orderof 100 kHz-1 gHz, through the skin 130 of the patient. In FIG. 9, allparts placed to the left of the skin 130 are located outside thepatient's body and all parts placed to the right of the skin 130 areimplanted. Any suitable remote control system may be used.

An external signal transmitting antenna 132 is to be positioned close toa signal receiving antenna 134 implanted close to the skin 130. As analternative, the receiving antenna 134 may be placed for example insidethe abdomen of the patient. The receiving antenna 134 comprises a coil,approximately 1-100 mm, preferably 25 mm in diameter, wound with a verythin wire and tuned with a capacitor to a specific high frequency. Asmall coil is chosen if it is to be implanted under the skin of thepatient and a large coil is chosen if it is to be implanted in theabdomen of the patient. The transmitting antenna 132 comprises a coilhaving about the same size as the coil of the receiving antenna 134 butwound with a thick wire that can handle the larger currents that isnecessary. The coil of the transmitting antenna 132 is tuned to the samespecific high frequency as the coil of the receiving antenna 134.

An external control unit 136 comprises a microprocessor, a highfrequency electromagnetic wave signal generator and a power amplifier.The microprocessor of the control unit 136 is adapted to switch thegenerator on/off and to modulate signals generated by the generator tosend digital information via the power amplifier and the antennas 132,134 to an implanted control unit 138. To avoid that accidental randomhigh frequency fields trigger control commands, digital signal codes areused. A conventional keypad placed on the external control unit 136 isconnected to the microprocessor thereof. The keypad is used to order themicroprocessor to send digital signals to either power or not power thestimulation device. The microprocessor starts a command by applying ahigh frequency signal on the antenna 132. After a short time, when thesignal has energised the implanted parts of the control system, commandsare sent to power the stimulation device. The commands are sent asdigital packets in the form illustrated below.

Start pattern, Command, Count, Checksum, 8 bits 8 bits 8 bits 8 bits

The commands may be sent continuously during a rather long time period.When a new power or not power step is desired the Count byte isincreased by one to allow the implanted control unit 138 to decode andunderstand that another step is demanded by the external control unit136. If any part of the digital packet is erroneous, its content issimply ignored.

Through a line 140, an implanted energiser unit 126 draws energy fromthe high frequency electromagnetic wave signals received by thereceiving antenna 134. The energiser unit 126 stores the energy in apower supply, such as a large capacitor, powers the control unit 138 andpowers the electric stimulation device 4 via a line 142.

The control unit 138 comprises a demodulator and a microprocessor. Thedemodulator demodulates digital signals sent from the external controlunit 136. The microprocessor of the control unit 138 receives thedigital packet, decodes it and, provided that the power supply of theenergiser unit 126 has sufficient energy stored, powers the stimulationdevice 4 via a line 144.

Alternatively, the energy stored in the power supply of the energiserunit may only be used for powering a switch, and the energy for poweringthe stimulation device 4 may be obtained from another implanted powersource of relatively high capacity, for example a battery. In this casethe switch is adapted to connect said battery to the control unit 138 inan on mode when the switch is powered by the power supply and to keepthe battery disconnected from the control unit in a standby mode whenthe switch is not powered.

What is claimed is:
 1. A heartburn and reflux disease treatmentapparatus, comprising: an implantable electrical stimulation deviceadapted to engage with the cardia sphincter of a patient, who suffersfrom heartburn and reflux disease, and electrically stimulate the cardiasphincter to increase the sphincter tonus, so that the cardia completelycloses, an electric source of energy, and a wireless remote controldevice controllable from outside the patient's body to control theelectric source of energy to supply the stimulation device with electricenergy, whenever the patient wants to during the day, when thestimulation device is implanted.
 2. An apparatus according to claim 1,wherein the electric source of energy is adapted to provide a currentthrough the electric conductors, and the control device is adapted tocontrol the electric source of energy to release electric energy suchthat the intensity of the current through the electric conductorsamounts to a predetermined value.
 3. An apparatus according to claim 2,wherein the control device is adapted to control the electric source ofenergy to release electric energy in the form of an alternating current.4. An apparatus according to claim 1, wherein the control devicecontrols the stimulation device.
 5. An apparatus according to claim 4,wherein the control device is adapted to control the stimulation deviceto vary the intensity of the electric stimulation of the cardiasphincter over time.
 6. An apparatus according to claim 5, wherein thecontrol device is controllable from outside the patient's body tocontrol the stimulation device to change the intensity of the electricstimulation of the cardia sphincter so that the tonus of the cardiasphincter is changed.
 7. An apparatus according to claim 4, wherein thecontrol device comprises an internal control unit implantable in thepatient for controlling the stimulation device.
 8. An apparatusaccording to claim 7, wherein the internal control unit is programmable.9. An apparatus according to claim 8, wherein the control devicecomprises an external control unit intended to be outside the patient'sbody, the internal control unit being programmable by the externalcontrol unit.
 10. An apparatus according to claim 9, wherein theexternal control unit loads the internal control unit with data inaccordance with a loading mode only authorised for a doctor.
 11. Anapparatus according to claim 9, wherein the external control unitcontrols the internal control unit in accordance with a doctor mode onlyauthorised for a doctor.
 12. An apparatus according to claim 9, whereinthe external control unit controls the internal control unit inaccordance with a patient mode permitted for the patient.
 13. Anapparatus according to claim 8, wherein the internal control unit isprogrammable for controlling the stimulation device over time.
 14. Anapparatus according to claim 13, wherein the internal control unitcontrols the stimulation device over time in accordance with an activityschedule program.
 15. An apparatus according to claim 13, wherein theinternal control unit comprises a microprocessor.
 16. An apparatusaccording to claim 1, further comprising at least one implantable sensorfor sensing at least one physical parameter of the patient.
 17. Anapparatus according to claim 16, wherein the sensor comprises a pressuresensor for directly or indirectly sensing as the physical parameter thepressure in the esophagus of the patient.
 18. An apparatus according toclaim 16, wherein the sensor senses as the physical parameter thecontraction wave in the esophagus caused by the patient swallowing food.19. An apparatus according to claim 18, wherein the electric stimulationdevice is adapted to cease the stimulation of the cardia sphincter inresponse to the sensor sensing the contraction wave in the patient'sesophagus.
 20. An apparatus according to claim 16, further comprising acontrol device adapted to control the stimulation device in response tosignals from the sensor.
 21. An apparatus according to claim 20, whereinthe control device comprises an internal control unit implantable in thepatient, the internal control unit controlling the stimulation device inresponse to signals from the sensor.
 22. An apparatus according to claim21, wherein the control device comprises an external control unitoutside the patient's body, the external control unit controlling thestimulation device in response to signals from the sensor.
 23. Anapparatus according to claim 22, wherein the external control unitstores information on the physical parameter sensed by the sensor and ismanually operated to control the stimulation device based on the storedinformation.
 24. An apparatus according to claim 16, further comprisingat least one implantable sender for sending information on the physicalparameter sensed by the sensor.
 25. An apparatus according to claim 16,wherein the sensor senses as the physical parameter when the patient islying down, and the electric stimulation device is adapted to maintainthe stimulation of the cardia sphincter in response to the sensorsensing that the patient is lying down.
 26. An apparatus according toclaim 1, wherein the source of energy is intended to be external to thepatient's body when the stimulation device is implanted therein, and thecontrol device is adapted to control the external source of energy torelease wireless energy for use in connection with the power of thestimulation device.
 27. An apparatus according to claim 26, furthercomprising an energy storage device implantable in the patient forstoring the wireless energy released from the external source of energy.28. An apparatus according to claim 27, wherein the energy storagedevice comprises an accumulator.
 29. An apparatus according to claim 28,wherein the accumulator comprises an electric accumulator.
 30. Anapparatus according to claim 29, wherein the electric accumulatorcomprises at least one capacitor or at least one rechargeable battery,or a combination of at least one capacitor and at least one rechargeablebattery.
 31. An apparatus according to claim 26, wherein the controldevice is adapted to control the external source of energy to releasewireless energy for direct use in connection with the power of thestimulation device.
 32. An apparatus according to claim 31, furthercomprising an activatable source of energy implantable in the patient,wherein the implantable source of energy is activated by wireless energyreleased from the external source of energy, to supply energy which isused in connection with the power of the stimulation device.
 33. Anapparatus according to claim 31, wherein the control device is adaptedto control the external source of energy to intermittently releasewireless energy in the form of a train of energy pulses for direct usein connection with the power of the stimulation device.
 34. An apparatusaccording to claim 33, wherein the control device is adapted to controlthe source of energy to release electric energy, and further comprisingan implantable capacitor for producing the train of energy pulses fromthe released energy.
 35. An apparatus according to claim 34, wherein thecapacitor has a capacity less than 0,1 μF.
 36. An apparatus according toclaim 26, further comprising an implantable stabiliser for stabilisingthe energy released by the control device.
 37. An apparatus according toclaim 36, wherein the energy released by the control device compriseselectric energy and the stabiliser comprises at least one capacitor. 38.An apparatus according to claim 31, wherein the wireless energycomprises electromagnetic waves excluding radio waves.
 39. An apparatusaccording to claim 26, wherein the wireless energy comprises a signal.40. An apparatus according to claim 26, further comprising animplantable energy transforming device for transforming wireless energydirectly or indirectly into electric energy for the power of thestimulation device.
 41. An apparatus according to claim 40, wherein theenergy transforming device transforms the wireless energy in the form ofsound waves into electric energy for the power of the stimulationdevice.
 42. An apparatus according to claim 41, wherein the energytransforming device comprises a capacitor.
 43. An apparatus according toclaim 42, wherein the capacitor is adapted to produce electric pulsesfrom the transformed electric energy.
 44. An apparatus according toclaim 1, further comprising a battery implantable in the patient forsupplying electric energy to implantable electric energy consumingcomponents of the apparatus.
 45. An apparatus according to claim 1,wherein the source of energy comprises an implantable internal source ofenergy.
 46. An apparatus according to claim 45, wherein the internalelectric source of energy comprises at least one accumulator, at leastone capacitor or at least one rechargeable battery, or a combination ofat least one capacitor and at least one rechargeable battery.
 47. Anapparatus according to claim 1, further comprising a switch implantablein the patient for directly or indirectly switching the power of thestimulation device.
 48. An apparatus according to claim 47, wherein thesource of energy comprises an internal electric source of energyimplantable in the patient for supplying electric energy to thestimulation device, and wherein the switch directly or indirectlyaffects the supply of electric energy from the internal electric sourceof energy.
 49. An apparatus according to claim 48, wherein the switchswitches between an “off” mode, in which the internal electric source ofenergy is not in use, and an “on” mode, in which the internal electricsource of energy supplies electric energy to the stimulation device. 50.An apparatus according to claim 47, wherein the source of energy isintended to be external to the patient's body and adapted to releasewireless energy for use in connection with the power of the stimulationdevice, and wherein the switch is operable by the wireless energyreleased from the external source of energy.
 51. An apparatus accordingto claim 48, further comprising an external source of energy adapted torelease wireless energy for use in connection with the power of thestimulation device, and an energy transforming device implantable in thepatient for transforming the wireless energy into electric energy, whichis stored by the internal electric source of energy.
 52. An apparatusaccording to claim 48, wherein the control device comprises a wirelessremote control for controlling the internal electric source of energy.53. An apparatus according to claim 52, further comprising an externalsource of energy adapted to release wireless energy for use inconnection with the power of the stimulation device, wherein the switchis operable by the wireless energy from the external source of energy toswitch between an “off” mode, in which the internal electric source ofenergy and remote control are not in use, and a “standby” mode, in whichthe remote control is permitted to control the internal electric sourceof energy to supply electric energy for the operation of the stimulationdevice.
 54. An apparatus according to claim 48, further comprising anexternal source of energy adapted to release wireless energy for use inconnection with the power of the stimulation device, an energytransforming device implantable in the patient for transforming thewireless energy into storable energy and an energy storage deviceimplantable in the patient for storing the storable energy.
 55. Anapparatus according to claim 54, wherein the switch is operable byenergy from the implantable energy storage device to switch between an“off” mode, in which the internal electric source of energy is not inuse, and an “on” mode, in which the internal electric source of energysupplies electric energy to the stimulation device.
 56. An apparatusaccording to claim 55, wherein the control device controls the energystorage device to operate the switch.
 57. An apparatus according toclaim 56, wherein the control device comprises a wireless remotecontrol.
 58. An apparatus according to claim 50, wherein the controldevice controls the external source of energy to release the wirelessenergy.
 59. An apparatus according to claim 58, wherein the switchswitches from an “off” mode, in which the internal electric source ofenergy is not in use, to an “on” mode, in which the internal source ofelectric energy supplies energy to the stimulation device.
 60. Anapparatus according to claim 59, wherein the control device controls theswitch to switch between the “on” and “off” modes.
 61. An apparatusaccording to claim 60, wherein the control device comprises a wirelessremote control.
 62. An apparatus according to claim 61, furthercomprising an external data communicator intended to be outside thepatient's body and an internal data communicator implantable in thepatient for communicating with the external communicator, wherein theinternal data communicator feeds data related to the patient back to theexternal data communicator or the external data communicator feeds datato the internal data communicator.
 63. An apparatus according to claim62, wherein the internal data communicator feeds data related to thestimulation device.
 64. An apparatus according to claim 62, wherein theinternal data communicator feeds data related to at least one physicalsignal of the patient.
 65. An apparatus according to claim 1, whereinthe control device controls the source of energy to release energy for adetermined time period.
 66. An apparatus according to claim 1, whereinthe control device controls the source of energy to release energy in adetermined number of energy pulses.
 67. An apparatus according to claim1, wherein the control device is adapted to control the source of energyto release energy in a non-invasive manner.
 68. An apparatus accordingto claim 1, wherein the control device comprises a wireless remotecontrol for transmitting at least one wireless control signal forcontrolling the stimulation device.
 69. An apparatus according to claim68, wherein the remote control is capable of obtaining information onthe condition of the stimulation device when the stimulation device isimplanted and to control the stimulation device in response to theinformation.
 70. An apparatus according to claim 68, wherein thewireless remote control comprises at least one external signaltransmitter or transceiver and at least one internal signal receiver ortransceiver implantable in the patient.
 71. An apparatus according toclaim 68, wherein the wireless remote control comprises at least oneexternal signal receiver or transceiver and at least one internal signaltransmitter or transceiver implantable in the patient.
 72. An apparatusaccording to claim 68, wherein the remote control transmits a carriersignal for carrying the control signal.
 73. An apparatus according toclaim 72, wherein the carrier signal is frequency, amplitude orfrequency and amplitude modulated.
 74. An apparatus according to claim72, wherein the carrier signal is digital, analogue or digital andanalogue.
 75. An apparatus according to claim 72, wherein the controlsignal used with the carrier signal is frequency, amplitude or frequencyand amplitude modulated.
 76. An apparatus according to claim 68, whereinthe control signal comprises a wave signal comprising one of a soundwave signal including an ultrasound wave signal, an electromagnetic wavesignal including an infrared light signal, a visible light signal, anultra violet light signal and a laser light signal, a micro wave signal,a radio wave signal, an x-ray radiation signal, and a gamma radiationsignal.
 77. An apparatus according to claim 68, wherein the controlsignal comprises an electric, magnetic or electric and magnetic field.78. An apparatus according to claim 68, wherein the control signal isdigital, analogue or digital and analogue.
 79. An apparatus according toclaim 78, wherein the remote control transmits an electromagneticcarrier wave signal for carrying the digital or analogue control signal.80. An apparatus according to claim 68, wherein the control signal istransmitted in pulses by the wireless remote control.
 81. An apparatusaccording to claim 1, wherein the stimulation device is embedded in asoft or gel-like material.
 82. An apparatus according to claim 1,wherein the stimulation device is embedded in a silicone material havinghardness less than 20 Shore.
 83. An apparatus according to claim 1,wherein the stimulation device comprises a band for application aroundthe cardia, the band having electric conductors for engaging the cardiasphincter.
 84. An apparatus according to claim 83, wherein the electricconductors comprise hooks to secure the conductors on the cardia.
 85. Anapparatus according to claim 84, wherein the hooks are inserted into thecardia.
 86. A heartburn and reflux disease treatment apparatuscomprising: an implantable electric stimulation device adapted to engagewith the cardia sphincter of a patient, who suffers from heartburn andreflux disease, and electrically stimulate the cardia sphincter toincrease the sphincter tonus, so that the cardia completely closes, andat least one implantable pressure sensor for directly or indirectlysensing the pressure in the esophagus of the patient.
 87. An apparatusaccording to 86, comprising a control device adapted to control thestimulation device in response to signals from the sensor.
 88. Anapparatus according to claim 87, wherein the control device comprises aninternal control unit implantable in the patient, the internal controlunit controlling the stimulation device in response to signals from thesensor.
 89. An apparatus according to claim 88, wherein the controldevice comprises an external control unit outside the patient's body,the external control unit controlling the stimulation device in responseto signals from the sensor.
 90. An apparatus according to claim 89,wherein the external control unit stores information on the pressuresensed by the sensor and is manually operated to control the stimulationdevice based on the stored information.
 91. A heartburn and refluxdisease treatment apparatus, comprising: an implantable electricstimulation device adapted to engage with the cardia sphincter of apatient, who suffers from heartburn and reflux disease, and electricallystimulate the cardia sphincter to increase the sphincter tonus, so thatthe cardia completely closes, a source of energy, and a control devicecontrollable from outside the patient's body for controlling the sourceof energy to release energy for use in connection with the power of thestimulation device, when the stimulation device is implanted, whereinthe control device includes an internal control unit implantable in thepatient for controlling the stimulation device.
 92. An apparatusaccording to claim 91, wherein the internal control unit isprogrammable.
 93. An apparatus according to claim 92, wherein thecontrol device comprises an external control unit intended to be outsidethe patient's body, the internal control unit being programmable by theexternal control unit.
 94. An apparatus according to claim 92, whereinthe internal control unit is programmable for controlling thestimulation device over time.
 95. An apparatus according to claim 94,wherein the internal control unit controls the stimulation device overtime in accordance with an activity schedule program.
 96. An apparatusaccording to claim 94, wherein the internal control unit comprises amicroprocessor.
 97. An apparatus according to claim 93, wherein theexternal control unit loads the internal control unit with data inaccordance with a loading mode only authorised for a doctor.
 98. Anapparatus according to claim 93, wherein the external control unitcontrols the internal control unit in accordance with a doctor mode onlyauthorised for a doctor.
 99. An apparatus according to claim 93, whereinthe external control unit controls the internal control unit inaccordance with a patient mode permitted for the patient.
 100. Aheartburn and reflux disease treatment apparatus, comprising: animplantable electric stimulation device adapted to engage with thecardia sphincter of a patient, who suffers from heartburn and refluxdisease, and electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes, a source ofenergy, and a control device controllable from outside the patient'sbody for controlling the source of energy to release energy for use inconnection with the power of the stimulation device, when thestimulation device is implanted, wherein the source of energy isintended to be external to the patient's body when the stimulationdevice is implanted therein, and the control device is adapted tocontrol the external source of energy to release wireless energy for usein connection with the power of the stimulation device.
 101. Anapparatus according to claim 100, further comprising an energy storagedevice implantable in the patient for storing the wireless energyreleased from the external source of energy.
 102. An apparatus accordingto claim 101, wherein the energy storage device comprises anaccumulator.
 103. An apparatus according to claim 102, wherein theaccumulator comprises an electric accumulator.
 104. An apparatusaccording to claim 103, wherein the electric accumulator comprises atleast one capacitor or at least one rechargeable battery, or acombination of at least one capacitor and at least one rechargeablebattery.
 105. An apparatus according to claim 100, wherein the controldevice is adapted to control the external source of energy to releasewireless energy for direct use in connection with the power of thestimulation device.
 106. An apparatus according to claim 105, furthercomprising an activatable source of energy implantable in the patient,wherein the implantable source of energy is activated by wireless energyreleased from the external source of energy, to supply energy which isused in connection with the power of the stimulation device.
 107. Anapparatus according to claim 105, wherein the control device is adaptedto control the external source of energy to intermittently releasewireless energy in the form of a train of energy pulses for direct usein connection with the power of the stimulation device.
 108. Anapparatus according to claim 107, wherein the control device is adaptedto control the source of energy to release electric energy, and furthercomprising an implantable capacitor for producing the train of energypulses from the released energy.
 109. An apparatus according to claim108, wherein the capacitor has a capacity less than 0,1 μF.
 110. Anapparatus according to claim 100, further comprising an implantablestabiliser for stabilising the energy released by the control device.111. An apparatus according to claim 110, wherein the energy released bythe control device comprises electric energy and the stabilisercomprises at least one capacitor.
 112. An apparatus according to claim100, wherein the wireless energy comprises electromagnetic wavesexcluding radio waves.
 113. An apparatus according to claim 100, whereinthe wireless energy comprises a signal.
 114. An apparatus according toclaim 100, further comprising an implantable energy transforming devicefor transforming wireless energy directly or indirectly into electricenergy for the power of the stimulation device.
 115. An apparatusaccording to claim 114, wherein the energy transforming devicetransforms the wireless energy in the form of sound waves into electricenergy for the power of the stimulation device.
 116. An apparatusaccording to claim 115, wherein the energy transforming devicetransforms the wireless energy in the form of sound waves directly intoelectric energy.
 117. An apparatus according to claim 115, wherein theenergy transforming device comprises a capacitor.
 118. An apparatusaccording to claim 117, wherein the capacitor is adapted to produceelectric pulses from the transformed electric energy.
 119. A heartburnand reflux disease treatment apparatus, comprising: an implantableelectric stimulation device adapted to engage with the cardia sphincterof a patient, who suffers from heartburn and reflux disease, andelectrically stimulate the cardia sphincter to increase the sphinctertonus, so that the cardia completely closes, an internal electric sourceof energy implantable in the patient for supplying electric energy tothe stimulation device, a wireless remote control for controlling theinternal electric source of energy, a switch implantable in the patientfor directly or indirectly switching the power of the stimulationdevice, and an external source of energy adapted to release wirelessenergy, wherein the switch is operable by the wireless energy from theexternal source of energy to switch between an “off” mode, in which theinternal electric source of energy and remote control are not in use,and a “standby” mode, in which the remote control is permitted tocontrol the internal electric source of energy to supply electric energyfor the operation of the stimulation device.
 120. A heartburn and refluxdisease treatment apparatus, comprising: an implantable electricstimulation device adapted to engage with the cardia sphincter of apatient, who suffers from heartburn and reflux disease, and electricallystimulate the cardia sphincter to increase the sphincter tonus, so thatthe cardia completely closes, an internal electric source of energyimplantable in the patient for supplying electric energy to thestimulation device, a switch implantable in the patient for directly orindirectly switching the power of the stimulation device, and anexternal source of energy adapted to release wireless energy, and anenergy transforming device implantable in the patient for transformingthe wireless energy into storable energy and an energy storage deviceimplantable in the patient for storing the storable energy.
 121. Anapparatus according to claim 120, wherein the switch is operable byenergy from the implantable energy storage device to switch between an“off” mode, in which the internal electric source of energy is not inuse, and an “on” mode, in which the internal electric source of energysupplies electric energy to the stimulation device.
 122. An apparatusaccording to claim 121, wherein the control device controls the energystorage device to operate the switch.
 123. An apparatus according toclaim 122, wherein the control device comprises a wireless remotecontrol.
 124. A heartburn and reflux disease treatment apparatus,comprising: an implantable electric stimulation device adapted to engagewith the cardia sphincter of a patient, who suffers from heartburn andreflux disease, and electrically stimulate the cardia sphincter toincrease the sphincter tonus, so that the cardia completely closes, aninternal electric source of energy implantable in the patient forsupplying electric energy to the stimulation device, a switchimplantable in the patient for directly or indirectly switching thepower of the stimulation device, and an external source of energyadapted to release wireless energy, and an energy transforming deviceimplantable in the patient for transforming the wireless energy intoelectric energy, which is stored by the internal source of energy. 125.An apparatus according to claim 124, wherein the switch switches from an“off” mode, in which the internal electric source of energy is not inuse, to an “on” mode, in which the internal source of electric energysupplies energy to the stimulation device.
 126. An apparatus accordingto claim 125, wherein the control device controls the switch to switchbetween the “on” and “off” modes.
 127. An apparatus according to claim126, wherein the control device comprises a wireless remote control.128. A heartburn and reflux disease treatment apparatus, comprising: animplantable electric stimulation device adapted to engage with thecardia sphincter of a patient, who suffers from heartburn and refluxdisease, and electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes, a source ofenergy, and a control device controllable from outside the patient'sbody for controlling the source of energy to release energy for use inconnection with the power of the stimulation device, when thestimulation device is implanted, wherein the control device comprises awireless remote control for transmitting at least one wireless controlsignal for controlling the stimulation device, the remote control beingcapable of obtaining information on the condition of the stimulationdevice when the stimulation device is implanted and to control thestimulation device in response to the information.
 129. An apparatusaccording to claim 128, further comprising at least one implantablesensor for sensing the condition of the patient.
 130. An apparatusaccording to claim 129, further comprising an internal control unitimplantable in the patient, the internal control unit controlling thestimulation device in response to signals from the sensor.
 131. Anapparatus according to claim 129, wherein the remote control stores theinformation on the condition of the stimulation device sensed by thesensor and is manually operated to control the stimulation device basedon the stored information.
 132. An apparatus according to claim 128,wherein the source of energy is intended to be external to the patient'sbody when the stimulation device is implanted therein, and the controldevice is adapted to control the external source of energy to releasewireless energy for use in connection with the power of the stimulationdevice.
 133. An apparatus according to claim 132, further comprising anenergy storage device implantable in the patient for storing thewireless energy released from the external source of energy.
 134. Anapparatus according to claim 133, wherein the energy storage devicecomprises an accumulator.
 135. An apparatus according to claim 134,wherein the accumulator comprises an electric accumulator.
 136. Anapparatus according to claim 135, wherein the electric accumulatorcomprises at least one capacitor or at least one rechargeable battery,or a combination of at least one capacitor and at least one rechargeablebattery.
 137. An apparatus according to claim 132, wherein the controldevice is adapted to control the external source of energy to releasewireless energy for direct use in connection with the power of thestimulation device.
 138. An apparatus according to claim 137, furthercomprising an activatable source of energy implantable in the patient,wherein the implantable source of energy is activated by wireless energyreleased from the external source of energy, to supply energy which isused in connection with the power of the stimulation device.
 139. Anapparatus according to claim 137, wherein the control device is adaptedto control the external source of energy to intermittently releasewireless energy in the form of a train of energy pulses for direct usein connection with the power of the stimulation device.
 140. Anapparatus according to claim 139, wherein the control device is adaptedto control the source of energy to release electric energy, and furthercomprising an implantable capacitor for producing the train of energypulses from the released energy.
 141. An apparatus according to claim140, wherein the capacitor has a capacity less than 0,1 μF.
 142. Aheartburn and reflux disease treatment apparatus, comprising: animplantable electric stimulation device adapted to engage with thecardia sphincter of a patient, who suffers from heartburn and refluxdisease, and electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes, a source ofenergy, and a control device controllable from outside the patient'sbody for controlling the source of energy to release energy for use inconnection with the power of the stimulation device, when thestimulation device is implanted, wherein the control device comprises awireless remote control for transmitting at least one wireless controlsignal for controlling the stimulation device and a carrier signal forcarrying the control signal.
 143. An apparatus according to claim 142,wherein the carrier signal is frequency, amplitude or frequency andamplitude modulated.
 144. An apparatus according to claim 142, whereinthe carrier signal is digital, analogue or digital and analogue.
 145. Anapparatus according to claim 142, wherein the control signal used withthe carrier signal is frequency, amplitude or frequency and amplitudemodulated.
 146. A heartburn and reflux disease treatment apparatus,comprising: an implantable electric stimulation device adapted to engagewith the cardia sphincter of a patient, who suffers from heartburn andreflux disease, and electrically stimulate the cardia sphincter toincrease the sphincter tonus, so that the cardia completely closes, asource of energy, and a control device controllable from outside thepatient's body for controlling the source of energy to release energyfor use in connection with the power of the stimulation device, when thestimulation device is implanted, wherein the control device includes awireless remote control for transmitting at least one wireless controlsignal for controlling the stimulation device, the wireless controlsignal including an electric, magnetic or electric and magnetic field.147. A heartburn and reflux disease treatment apparatus, comprising: animplantable electric stimulation device adapted to engage with thecardia sphincter of a patient, who suffers from heartburn and refluxdisease, and electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes, a source ofenergy, and a control device controllable from outside the patient'sbody for controlling the source of energy to release energy for use inconnection with the power of the stimulation device, when thestimulation device is implanted, wherein the control device includes awireless remote control for transmitting at least one wireless controlsignal for controlling the stimulation device, the wireless controlsignal being transmitted in pulses by the wireless remote control. 148.A heartburn and reflux disease treatment apparatus, comprising: animplantable electric stimulation device adapted to engage with thecardia sphincter of a patient, who suffers from heartburn and refluxdisease, and electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes, wherein thestimulation device is embedded in a soft or gel-like material.
 149. Aheartburn and reflux disease treatment apparatus, comprising: animplantable electric stimulation device adapted to engage with thecardia sphincter of a patient, who suffers from heartburn and refluxdisease, and electrically stimulate the cardia sphincter to increase thesphincter tonus, so that the cardia completely closes, wherein thestimulation device is embedded in a silicone material having hardnessless than 20 Shore.
 150. A heartburn and reflux disease treatmentapparatus, comprising: an implantable electric stimulation deviceadapted to engage with the cardia sphincter of a patient, who suffersfrom heartburn and reflux disease, and electrically stimulate the cardiasphincter to increase the sphincter tonus, so that the cardia completelycloses, wherein the stimulation device includes a band for applicationaround the cardia, the band having electric conductors for engaging thecardia sphincter, the electric conductors including hooks to secure theconductors on the cardia.
 151. An apparatus according to claim 150,wherein the hooks are inserted into the cardia.